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An elderly woman sprawls on the floor beside her walker. She has fallen, and she obviously needs help.

The ad’s voice-over says that Boston firefighters typically respond to a 911 call within four minutes. “But only if your medical emergency is on the mayor’s list,’’ the narrator says, asserting that firefighters are not authorized to respond to certain kinds of emergencies, as a photo shows a grimacing Mayor Thomas M. Menino.

The radio spot and an accompanying video on YouTube are the latest salvos fired by Boston Fire Fighters Local 718, warning that the mayor’s policies are endangering public safety.

Embroiled in a longstanding dispute with the mayor, Boston firefighters have not just endorsed the mayor’s challenger, Councilor at Large Michael F. Flaherty Jr. They have inserted themselves deeply into the campaign, boosting Flaherty when he is low on funds. But their actions have associated Flaherty, at times uncomfortably, with a union that is controversial because of the high usage of sick leave by firefighters and the union’s resistance to mandatory drug and alcohol testing without more pay.

“There was a time not so long ago when Boston firefighters were emulated by their peers across the country,’’ union president Edward J. Kelly said in an e-mail, after declining an interview request. “But under the current administration, the critical public safety infrastructure of the Fire Department has been allowed to collapse. We’re taking our message to the streets this election season, because the citizens of Boston deserve to know the truth about their Boston firefighters.’’

The firefighters are making their case through a website, www.FireFightTheSmears.com, a blog, a Facebook page, a YouTube channel and a Twitter feed. Samples of their Tweets include “@mayortommenino continues putting politics before public safety,’’ and “Responding to a disaster is just a distraction to @mayortommenino.’’

They are running hard-hitting print ads in neighborhood weeklies. One shows a photo of a firefighter carrying a young girl from a burning building and states, “This firehouse was temporarily closed on July 12th. Luckily for this little girl, this fire did not happen on July 12th.’’

Another ad says the Menino administration “contributed to the death of Kevin Kelley,’’ referring to Lieutenant Kevin M. Kelley, the firefighter killed in January when the brakes failed on his firetruck and it slammed into a building in Mission Hill.

And the union is airing a variety of radio and television ads, including one this week narrated by former mayor Raymond L. Flynn, saying that fire equipment is obsolete and morale is at an all-time low. Flynn, whose brother was the maintenance superintendent for the Fire Department, has endorsed Flaherty in the mayoral campaign.

Flaherty’s campaign has sometimes seemed to squirm over the allegiance with firefighters, whose public image has darkened in recent years under allegations of wrongdoing, including questionable disability claims and a firefighter caught lifting weights in a bodybuilding competition six weeks after filing a disability claim saying he was permanently incapacitated. “The firefighters [union], as a part of our organization, is pretty small,’’ said Flaherty’s spokeswoman Natasha Perez. “In a week, we probably have 600 volunteers doing something, and maybe 60 of them are firefighters.’’

Menino campaign spokesman Nick Martin said, “It would be counterproductive for us to answer all the baseless allegations Local 718 has put out.’’

But city officials said it is not true that the mayor has stopped firefighters from responding to medical emergencies, as suggested in the ad with the elderly woman. They said that certain medical emergencies were never handled by firefighters and that no changes to this policy have been made in years. “It’s just a matter of them simply not telling the truth,’’ Martin said.

The firefighters are not the only labor union trying to influence the outcome of Boston’s mayoral campaign. The Patriot Majority, a political advocacy organization funded in part by a union of health care workers, SEIU Local 1199, is running television ads praising Menino.

But the firefighters have positioned themselves as an uncommon force to be reckoned with, and they are using the campaign to amplify their grievances against City Hall. One early success: Firefighters waged a postcard campaign that prompted so many people to e-mail WCVB Channel 5 before the Oct. 1 televised debate that they succeeded in persuading the debate moderators to question the mayor, on-air, about why the Fire Department has no dedicated hazardous-materials unit, a favorite issue of the union.

The Boston Fire Fighters Local 718 Political Action Committee gave Flaherty the maximum $500 this year, as did the state firefighters’ PAC, the Professional Firefighters of Massachusetts. Individual donors who identified themselves as city firefighters gave Flaherty another $16,585 this year.

As a candidate, Flaherty has embraced the firefighters’ agenda, seizing on the idea of a hazardous-materials unit and, in the heat of July, capitalizing on public concerns over firehouse “brownouts.’’ At the time, firefighters were financing automated phone calls to residents and driving around neighborhoods with bullhorns, warning of potentially dire consequences as a result of a new city policy that closed four firehouses at a time rather than paying overtime when too many members called in sick. Flaherty urged the mayor to reopen the firehouses, saying, “Tom Menino has let his fight with the firefighters get in the way of public safety.’’

Martin charged that the union’s campaign is aimed at diverting attention from its insistence on being compensated for drug and alcohol testing. The city has been pushing for such testing, particularly since autopsies on two firefighters killed in a 2007 restaurant fire found alcohol in one man’s body and cocaine in the other’s.

Flaherty has said he would require drug and alcohol testing of firefighters but has not said how he would handle their request for a salary increase.

The firefighters have long scrapped with Menino, picketing his State of the City address in 2001 and threatening to disrupt the Democratic National Convention in Boston in 2004. The union endorsed Menino in 2005, but tensions have risen since their contract expired in 2006. Local 718 and the city are now in arbitration.

“They have delayed this process at every turn in hopes of Michael Flaherty winning the election,’’ said John Dunlap, the mayor’s director of labor relations. “They’ve got everything riding on him.’’

Michael Levenson of the Globe staff contributed to this report. Stephanie Ebbert can be reached at ebbert@globe.com.